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Financial Alignment Initiative

Financial Alignment Initiative for Medicare-Medicaid Enrollees

The Financial Alignment Initiative is designed to provide individuals dually enrolled in Medicare and Medicaid with a better care experience and to better align the financial incentives of both programs. CMS partners with states to test two models: a Capitated Model and a Managed Fee-for-Service Model. These models aim to integrate primary, acute, behavioral health, and long-term services and supports.

Active since 2013-01-01

Innovation

Testing two new models: a Capitated Model utilizing a three-way contract and prospective blended payments, and a Managed Fee-for-Service Model allowing states to benefit from savings resulting from quality improvement and cost reduction initiatives.

The Problem

There are over 12 million Americans enrolled in both the Medicare and Medicaid programs who need access to high quality, seamless systems of care that better coordinate benefits and services.

The Solution

CMS is working with States to test two models to integrate primary, acute, behavioral health and long-term services and supports for dually eligible individuals and better align the financing of the Medicare and Medicaid programs.

Expected Outcomes

A better care experience for dually enrolled individuals, improved quality of care, reduced costs for both Medicare and Medicaid, and better aligned financial incentives between the two programs.

Strategy

Collaboration between the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office to partner with states and test new models for their effectiveness in accomplishing care and financial alignment goals.

Model Goals

  • Provide individuals dually enrolled for Medicare and Medicaid with a better care experience
  • Better align the financial incentives of the Medicare and Medicaid programs
  • Increase access to high quality, seamless systems of care that better coordinate benefits and services

Patient Eligibility

Individuals must be dually enrolled in both the Medicare and Medicaid programs.

  • Dually enrolled for Medicare and Medicaid

Provider Eligibility

States must submit a proposal and develop a Memorandum of Understanding (MOU) with CMS. For the Capitated Model, health plans must enter into a three-way contract with the State and CMS.

  • State must develop a Memorandum of Understanding (MOU) with CMS
  • Health plans must enter into a three-way contract with the State and CMS (Capitated Model)

Care Categories

Comprehensive Care

Primary CareAcute CareBehavioral HealthLong-Term Services and Supports

CMS Benchmarks & Thresholds

operational

Performance Period Duration72
Number of Models within Initiative2
Number of Participating States13

population

Dually Eligible Population Count12,000,000

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